Is this a joke?
Of course choices have to be made
But IMHO opinion the wrong ones are selected
Am old dog so you know where I am
Coming from.......
We trained when there were
No cat scans,Mris,monoclonal antibodies,echocardiograms
If you performed a history and physical exam without
Rectal,pelvic,fundiscoptic and consistently missed
Physical pathological findings with your attending
You usually did not graduate.
There is no excuse for this.
If nothing else have the drive and determination
To learn it on your own.
So get a book
Don't read it
Learn it
Disgraceful.
Point about all testing:
There are always false positives and false negatives no matter
What.
Then there is that problem with "The BellShaped Curve"
What if your patient is outside the curve?
Ever hear of lab,radiology,etc
Performing the wrong test on the wrong patient?
Ever see a hemolytic transfusion
Because someone put the wrong name on
Patients tube for crossmatch?
Ever see a test just plain give the wrong answer
Ever hear of idiot values?
Ever see blood cultures mixed up?
If doctors. Can't do excellent physical exam
Who teaches Faps and Nurse practioners to
Do them correctly?
I know I am just a ranting old dog
And nobody ever wants to hear from them anyway
But this is just wrong wrong wrong,lazy,
Half-assed dangerous and insane......
At this rate the Faps and Nps really
Will provide better care eventually
Who needs a doctor that cannot
Perform physical exam?
They are worthless..

James Goodman

05/21/14

Oh yes
Perhaps they should add to the Stanford list
Check and see if your patient is breathing
And has a pulse.
Could be of value
old dog.

william doolittle

05/21/14

Havung spent several weeks in the hospital, I agree with "Stanford 25". I was assigned to an Internist for
followup, and his view a complete physical is apparently sans examination of any cavities. I thought he
hadn't a stethoscope until he showed one two visits ago..

Susan Pfettscher, PhD, RN

05/22/14

THANK YOU, THANK YOU, THANK YOU for this article. As a peritoneal
dialysis nurse, nothing is making me crazier and sadder than
reading the physical exams done on my patients while they are in
the hospital or seen in ERs or urgent care facilities. Rarely do
any of these exams acknowledge that these patients have a "tube
sticking out of their abdomens." I know they could not describe it
in medical terms! Yet they record that they have done a full
abdominal exam. In addition, sometimes they will decide that they
have peritonitis even when they are asymptomatic of that problem--
yet no mention of a catheter. Finally, this problem extends beyond
physical exams--imaging reports of the abdomen (CT, etc)rarely, if
ever, notes that a catheter is present in the peritoneal cavity!
Sometimes, I wonder whose images the radiologists are reading. I
fear for my patients when they are in hospitals, ERs, urgent care
centers and do everything in my power to keep them away from those
places..

Molly_Rn

05/22/14

As an ICU/CCU nurse I have had to remind residents to actually look
at the patient! The irony is that the most experienced physicians
and nurses not only examine the patient but they also use all of
their senses to observe the patient and that good old gut feeling
that something isn't quite right. Technology isn't always right. I
have had patients that maintain good numbers while they were trying
to die; a woman with an ectopic pregnancy bleeding out into her
right quadrant while her BP and pulse were perfectly normal
(palating her abdomen and listening to what she was saying... the
old "I feel real bad" found the problem.).

Linda Mann, RNP, retired

05/22/14

I was trained as an Internal Medicine Registered Nurse Practitioner in the early 1970s in a program started by Drs
Alvin Sanborn and Raymond Kay of Kaiser Permanente. The participants were RNs with experience in multiple
areas of in-patient care.
Our clinical examination teaching began immediately and we used textbooks intended for physicians and medical
students. Our mentors had patients with multiple conditions whom they had seen for many years, who liked having
their exams done by both the doctor and RNP! The doctors would teach while examining and then we would do the
same...over and over. We received specialty lectures in rheumatology, oncology, endocrinology, and so on. A
thorough traditional history was stressed.
I literally performed thousands of H &amp; Ps during my career and I'm sure could do one today if asked. Our learning
included every one of the skills noted in this article, and more. I diagnosed odd lines on my own fingernails as
Beau's lines after being found to have MAC/Bronchiectasis. These days as a patient I'm astounded by the cursory
respiratory and cardiac examinations I receive, with the exception of those by RNPs and my experienced Family
Practitioner..

shakerbee

05/22/14

This is truly pathetic. When I was in college I was admitted with
pneumonia. Each day there was a stream of medical students,
interns and residents coming to examine me- I evidently had a
classic physical exam. When I got to medical school I understood
why I was asked to say baseball and "E" over and over plus had
people pressing on my back for fremitus. Now it would be a website
to try to hear egophony..

Doug Woolley MD,FRCS(c),FACS

05/23/14

Over 100 years ago Sir William Osler sais it best; "It is more
important to know the patient than what disease the patient has!"
As a retired orthopedist who has had had 4 major orthopaedic
procedure in the last 4 years I have now found the History taking
has been replaced by forms that nobody seems to read, the physical
has become a chopped salad of different practitioners adding
different condiments with a lack of indifference and varying
expertise.
My advice is try to have everything done in a surgery center close
to home here you have a chance of being taken care of by people who
know you. Go directly home where you can have some control over you
care. My recent experience in an university hospital where it is
filled with people who do not know who you are nor have any
diagnostics skills made me believe I easily could have died from
the worse gastritis(gastric ulcer) I have ever had as nobody could
properly examine an acute abdomen. I never saw my surgeon in the
hospital after he put my cast on for my below knee amputation nor
in the hospital or the follow up outpatient clinic despite problems
with my gastritis, intractable hiccups and florid Phantom Limb
Pain. None of the team members offered any solutions. All in all a
sad situation that embarrasses me as I could have this done in my
hometown without all the hassle.
If the government wants to save money and our profession wants to
prevent frivolous lawsuits they need to start looking at our
institutions of higher learning as my recent experience suggests
hands on care of the patient has not improved from my training 40
years ago and indeed has deteriorated..

This survey is a poll of those who choose to participate and are, therefore, not valid statistical samples, but rather a snapshot of what your colleagues are thinking.

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